ST ALOISIUS HOSPITAL INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- ST ALOISIUS HOSPITAL INC (EIN 45-0226729)
- Tax period
- 2017-10-01 to 2018-09-30
- Filed
- 2019-08-13
- IRS object ID
- 201932259349301703
- Schema version
- 2017v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-08-13T11:38:09-05:00 | ReturnTs |
| Tax Period End | 2018-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Eide Bailly LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 Nicollet Mall Ste 1300 | AddressLine1Txt |
| City | Minneapolis | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554027033 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450226729 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Aloisius Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STAL | BusinessNameControlTxt |
| Phone | 7013244651 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 325 Brewster Street East | AddressLine1Txt |
| City | Harvey | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58341 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Michael Zwicker | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7013244651 | PhoneNum |
| Signature | 2019-07-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kim Hunwardsen CPA | PreparerPersonNm |
| PTIN | P00484560 | PTIN |
| Phone | 6122536500 | PhoneNum |
| Preparation | 2019-07-09 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 216.147.181.47 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-07-10 | IPDt |
| IP Tm | 14:53:18 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | B602D594AFD2B0B327E07A06F36CA6A7E42546D0 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 330E77A2EC15986A2DC713C7FDB26B906589BB96 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Aloisius Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Michael Zwicker | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 325 Brewster Street East | AddressLine1Txt |
| City | Harvey | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58341 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $15,618,607 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.staloisius.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1938 | FormationYr |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Activity Or Mission | Provide healthcare and healing services with special concern for the elderly and poor | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 284 | TotalEmployeeCnt |
| Total Volunteers | 47 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $47,515 | PYContributionsGrantsAmt |
| CY Contributions Grants | $49,616 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $15,007,390 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $15,298,837 | CYProgramServiceRevenueAmt |
| PY Investment Income | $97,094 | PYInvestmentIncomeAmt |
| CY Investment Income | $138,242 | CYInvestmentIncomeAmt |
| PY Other Revenue | $14,400 | PYOtherRevenueAmt |
| CY Other Revenue | $125,625 | CYOtherRevenueAmt |
| PY Total Revenue | $15,166,399 | PYTotalRevenueAmt |
| CY Total Revenue | $15,612,320 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,842,144 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,329,211 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,484,681 | PYOtherExpensesAmt |
| CY Other Expenses | $6,468,823 | CYOtherExpensesAmt |
| PY Total Expenses | $15,326,825 | PYTotalExpensesAmt |
| CY Total Expenses | $15,798,034 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$160,426 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$185,714 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $17,382,410 | TotalAssetsBOYAmt |
| Total Assets EOY | $17,511,498 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,363,321 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $8,424,919 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $9,019,089 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,086,579 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | St. Aloisius Medical Center, inspired by Jesus, in union with the Sisters of Mary of the Presentation, ministers health to all we serve. | MissionDesc |
| Significant New Program Srvc | Yes (1) | SignificantNewProgramSrvcInd |
| Significant Change | Yes (1) | SignificantChangeInd |
| Expense | $14,120,884 | ExpenseAmt |
| Revenue | $15,398,837 | RevenueAmt |
| Desc | CRITICAL ACCESS HOSPITAL DESIGNATIONSt. Aloisius is a 25-bed acute care hospital and 85-bed nursing facility located in Harvey, North Dakota. The Hospital was designated as a Critical Access Hospital in 2002. As a critical access hospital, our role is vital to the health and welfare of the community we serve. The patient and resident days for FY 2018 were as follows: 563 acute days, 1,389 swing-bed days, and 27,407 nursing home days. RESPONDING TO THE NEEDS OF THE POORThe Community Liason has continued assisting with the volunteer programs such as Hospice and Long Term Care. (Continued on Schedule O) The Medical Center provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Because the Medical Center does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The estimated costs of the charges foregone, based upon an overall cost-to-charge ratio calculation, for the years ended September 30, 2018 was $1,000.In addition, the Medical Center provides services to other medically indigent patients under certain government-reimbursed public aid programs. Such programs pay providers amounts which are less than established charges for the services provided to the recipients, and for some services the payments are less than the cost of rendering the services provided. The Medical Center also commits significant time and resources to endeavors and critical services which meet otherwise unfulfilled community needs. Many of these activities are sponsored with the knowledge that they will not be self-supporting or financially viable.St. Aloisius provides a Senior Living Facility. This consists of 16 apartment units. Two of the one-bedroom apartments are handicap accessible. A noon meal is optional but is served 7 days per week. There is also a 24-hour emergency call system.St. Aloisius Long Term Care is an 85-bed skilled nursing facility licensed by the State of North Dakota. The facility provides occupational, physical and speech therapy and other activities offered 7 days per week. | Desc |
| Total Program Service Expenses | $14,120,884 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 33 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 284 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Sandra Teubner | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7013244651 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 325 Brewster Street East | AddressLine1Txt |
| City | Harvey | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58341 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Daniel Stutlien | ||||||||
| Chair | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Susan Shearer | ||||||||
| Vice Chair | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Sr Elaine Lange | ||||||||
| Secretary non-voting | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Sr Elizabeth Rose Muscha | ||||||||
| Director | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Sr Marlyss Dionne | ||||||||
| Director | 0.50 | 1.30 | Yes (X) | $0 | $0 | $0 | ||
| Chad Ziegler | ||||||||
| Director | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Jason Schneider | ||||||||
| Director | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Gordon Schmidt | ||||||||
| Director | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Michael Zwicker | ||||||||
| President/CEO | 40.00 | 0.00 | Yes (X) | $0 | $200,000 | $23,257 | ||
| Sandra Teubner | ||||||||
| CFO | 40.00 | 0.00 | Yes (X) | $0 | $142,626 | $32,681 | ||
| Kimberly Thorson | ||||||||
| Nurse Practitioner | 40.00 | 0.00 | $175,865 | $0 | $5,276 | Yes (X) | ||
| Toni Bromley | ||||||||
| Pharmacist | 40.00 | 0.00 | $114,548 | $0 | $3,436 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $290,413 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $342,626 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $64,650 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Sisters of Mary of the Presentation Heal | |||||
| 1202 Page Drive SW PO BOX 10007 | Fargo | ND | 581060007 | Administrative services | $730,735 |
| Dakota Travel Nurses | |||||
| 1200 Collins Ave | Mandan | ND | 58554 | Contracted nursing | $487,104 |
| CDFP PC | |||||
| 922 Lincoln Ave | Harvey | ND | 58341 | Medical director fees & ER physician | $180,105 |
| CPSI | |||||
| PO Box 850309 | Mobile | AL | 36685 | IT services | $147,766 |
| Homestead Recruiters | |||||
| 821 Senior Ave | Dickinson | ND | 58601 | Physician locum tenens services | $131,188 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $42,158 | GovernmentGrantsAmt |
| All Other Contributions | $7,458 | AllOtherContributionsAmt |
| Total Contributions | $49,616 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenue | 622110 | $14,829,263 | $14,829,263 |
| Senior living | 623990 | $89,111 | $89,111 |
| Daycare services | 624410 | $49,036 | $49,036 |
| EHR incentive payment | 900099 | $45,500 | $45,500 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $285,927 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $285,927 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $15,298,837 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $144,529 | TotalRevenueColumnAmt |
| Exclusion | $144,529 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $25,625 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $25,625 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,625 | TotalRevenueColumnAmt |
| Exclusion | $25,625 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $6,287 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$6,287 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$6,287 | TotalRevenueColumnAmt |
| Exclusion | -$6,287 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Sale of bed licenses | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $100,000 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $100,000 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $100,000 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,612,320 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,398,837 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $163,867 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,330,473 | TotalAmt |
| Program Services | $6,865,481 | ProgramServicesAmt |
| Management And General | $464,992 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $180,642 | TotalAmt |
| Program Services | $176,090 | ProgramServicesAmt |
| Management And General | $4,552 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,295,357 | TotalAmt |
| Program Services | $1,185,634 | ProgramServicesAmt |
| Management And General | $109,723 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $522,739 | TotalAmt |
| Program Services | $490,713 | ProgramServicesAmt |
| Management And General | $32,026 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,500 | TotalAmt |
| Management And General | $46,500 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,081,412 | TotalAmt |
| Program Services | $1,289,544 | ProgramServicesAmt |
| Management And General | $791,868 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,355 | TotalAmt |
| Management And General | $20,355 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $408,324 | TotalAmt |
| Program Services | $307,847 | ProgramServicesAmt |
| Management And General | $100,477 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $431,783 | TotalAmt |
| Program Services | $431,783 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,491 | TotalAmt |
| Program Services | $32,189 | ProgramServicesAmt |
| Management And General | $13,302 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,915 | TotalAmt |
| Program Services | $23,915 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $383,176 | TotalAmt |
| Program Services | $383,176 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,126,995 | TotalAmt |
| Program Services | $1,126,995 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73,123 | TotalAmt |
| Program Services | $73,123 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical supplies | $691,354 | $691,354 | |
| Repairs and maintenance | $423,256 | $330,243 | $93,013 |
| Dietary food | $365,031 | $365,031 | |
| Bad debt expense | $320,684 | $320,684 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,424 | TotalAmt |
| Program Services | $27,082 | ProgramServicesAmt |
| Management And General | $342 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,798,034 | TotalAmt |
| Program Services | $14,120,884 | ProgramServicesAmt |
| Management And General | $1,677,150 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,241,020 | BOYAmt |
| EOY | $918,787 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,356,754 | BOYAmt |
| EOY | $1,800,163 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,869 | BOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $166,339 | BOYAmt |
| EOY | $152,457 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $174,080 | BOYAmt |
| EOY | $131,742 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $22,248,654 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $13,568,575 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,128,371 | BOYAmt |
| EOY | $8,680,079 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,085,042 | BOYAmt |
| EOY | $5,820,324 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $228,935 | BOYAmt |
| EOY | $7,946 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,382,410 | BOYAmt |
| EOY | $17,511,498 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,103,842 | BOYAmt |
| EOY | $1,107,219 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,494 | BOYAmt |
| EOY | $1,335 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,935 | BOYAmt |
| EOY | $7,946 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,205,050 | BOYAmt |
| EOY | $7,299,419 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $9,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,363,321 | BOYAmt |
| EOY | $8,424,919 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,935,829 | BOYAmt |
| EOY | $9,004,619 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $83,260 | BOYAmt |
| EOY | $81,960 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,019,089 | BOYAmt |
| EOY | $9,086,579 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,382,410 | BOYAmt |
| EOY | $17,511,498 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$185,714 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $263,008 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$9,804 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $102,501 | OtherCostOrOtherBasisAmt |
| Book Value | $102,501 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,137,586 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,714,553 | DepreciationAmt |
| Book Value | $7,423,033 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,679,585 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,596,565 | DepreciationAmt |
| Book Value | $1,083,020 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $328,982 | OtherCostOrOtherBasisAmt |
| Depreciation | $257,457 | DepreciationAmt |
| Book Value | $71,525 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,680,079 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | SMPHS pooled investment funds | Desc |
| Book Value | $5,820,324 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $5,820,324 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Estimated third-party payor settlements | Desc |
| Amt | $9,000 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $9,000 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $15,554,644 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $263,008 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$320,684 | OtherRevenueAmt |
| Revenue Not Reported | -$57,676 | RevenueNotReportedAmt |
| Revenue Subtotal | $15,612,320 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $15,612,320 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $15,477,350 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $15,477,350 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $320,684 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $320,684 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $15,798,034 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part IV, Line 2b: | The Medical Center hold funds under an agency relationship for the residents of the nursing facility. Funds held as of September 30, 2018 totaled $7,946. |
| Part X, Line 2: | The Medical Center is organized as a North Dakota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Medical Center is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Medical Center is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose, if applicable. The Medical Center has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. The Medical Center believes that it has appropriate support for any tax position taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Medical Center would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 175.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $239,817 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $131,504 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $108,313 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00700 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $240,817 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $131,504 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $109,313 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00710 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $478,751 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $42,815 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $435,936 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02820 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,119,379 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $948,427 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $170,952 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01100 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,807 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $155 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $11,652 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,609,937 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $991,397 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $618,540 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04000 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,850,754 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,122,901 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $727,853 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04710 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,148 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,830 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,318 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,148 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,830 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,318 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $320,684 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $18,279 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,430,188 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,491,290 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$61,102 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Aloisius Medical Center | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 325 Brewster Street East | AddressLine1Txt |
| City | Harvey | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58341 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.staloisius.com | WebsiteAddressTxt |
| State License | 5023a | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Aloisius Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Part V, Page 8 | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.staloisius.com/resources-policies.html | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 175.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | www.staloisius.com/resources-policies.html | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.staloisius.com/resources-policies.html | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | www.staloisius.com/resources-policies.html | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| St. Aloisius Hospital | Part V, Section B, Line 5: One-on-one interviews with key informants were conducted in person in Harvey. St. Aloisius Medical Center's administrators identified certain individuals as "community leaders" who could provide insights into the community's health needs. These key informants represented the broad interests of the community served by St. Aloisius. They included representatives of the health community, business community, faith community, nonprofit agencies, and public health. Included among the informants was a public health nurse with special knowledge in public health acquired through several years of direct care experience in the community, including working with medically underserved, low income and minority populations, as well as with populations with chronic diseases. |
| St. Aloisius Hospital | Part V, Section B, Line 11: Fiscal year 2018 updates to the Implementation Strategy are as follows:Tier I Needs I. Physician Retention and Recruitment One of the main concerns arising from the community needs assessment is maintaining an adequate medical staff to serve the community. At the time the survey was conducted, Harvey had only one physician (Down from 3 in the prior assessment), one physician assistant and four nurse practitioners (one more NP than the prior assessment). Since the last survey, we've contracted with Avera McKennan Healthcare for e-Emergency services. St. Aloisius is connected continuously via telemedicine to an emergency room physician in Sioux Falls. The arrangement with Avera provides all the benefits we hoped for and improves the operations of our Emergency Room. We've successfully used Mid-levels in the emergency room as well. The e-Emergency initiative is partly responsible for the use of mid-level providers in the ER. Nurse Practitioners and Physicians Assistants are in the call rotation and improved on call coverage for our provider. St. Aloisius Medical Center contracted with Jackson Coker Physician Recruiters and The In-Line Group (Recruiters) to recruit a primary care physician. Interest in our opportunity is low and we were only able to convince one physician to come to Harvey for an interview. University of North Dakota has been a great partner recently. We are working with them to identify medical students willing to choose to work in a rural community. We are in contact with one first year resident and hope to cultivate a relationship resulting in employment.OBJECTIVE:Attract two primary care physicians for the St. Aloisius service area.Results 2017-2018:We hired two full time family practice doctors to work in St. Aloisius Medical Center's new clinic. Furthermore, we hired one Specialty Doctor (Osteoporosis/Bone Health) who is working one day per month in the clinic.One full time family nurse practitioner was hired to consistently cover Emergency Department calls.We are currently evaluating another full-time family practice doctor who is anticipated to start in the spring of 2019.II. Access to Specialists Our community identified a number of specialty services they felt were needed in our community. Podiatry, Orthopedics, Allergy, and Behavioral Health were often mentioned in interviews and in community meetings. Additionally, access to maintenance chemotherapy and dialysis were important. We've joined sister facilities to include the closest tertiary facility in Minot (Trinity Healthcare) to coordinate resources throughout the Northwest region of North Dakota. The first substantive meetings of the group were scheduled to occur as we completed our Community Health Needs Assessments. This collaboration is a strong first step towards bringing specialists to Harvey on a rotating basis. Additionally, we've met with a tele-psychiatry provider. They currently provide ER coverage to a number of critical access hospitals throughout Minnesota, North and South Dakota. We plan to open clinic hours for tele-psychiatry. We've met with Dr. Mary Aaland of the UND Rural Surgery Program. Dr. Aaland currently rotates throughout rural hospitals providing clinic visits and minor surgical procedures. We believe we could open two surgical days per month initially and grow the program from that point.OBJECTIVE:Attract specialists, on a rotating basis, to deliver services within the St. Aloisius service area.Results 2017-2018:One physician was hired to work one day per month. The physician specializes in Bone Health/Osteoporosis and will be the Medical Director over the Medical Center's new DXA scanner.Working with CEO from Rugby to increase Dr. Skipper's (surgeon) time from one to two days per month.In communication with Trinity of Minot to partner in sharing a Pulmonologist, Cardiologist and Pediatrician to work in Harvey one to two days per month.Increased mental health consultation days by one extra day per month (3rd Monday) in addition to maintaining every Tuesday's scheduleTier II Needs I. Access to fitness equipment, healthy eating, substance abuse education, and support group St. Aloisius Medical Center will work collaboratively with the Wells County District Health Unit to address healthy living needs in the community. The two organizations already enjoy a strong relationship and are well positioned to address issues important to the improvement of community health status.OBJECTIVE:Improve health status of the community by addressing fitness, dietary, substance abuse, and education needs. Results 2017-2018:The hospital became an accredited hospital for diabetes education.Cardiac Ready Community work started in September of 2017 for Harvey and Fessenden. Time was committed to this project to assess the needs of AED's in our communities, screen for hypertension and educate our communities on healthy lifestyles to improve cardiac fitness. Collaboration with city leaders, police, EMS and St. Aloisius staff on lead team.St. Aloisius and lead team continued to work on the cardiac ready project placing several AED's in public places, church's and businesses. Hands only CPR education for the public continued as well.The hospital collaborated with Wells County District Health (WCDHU) to utilize the clinic in Fessenden, ND as their main branch location beginning January 1, 2018. This relationship will improve the opportunities for improving wellness to Harvey and surrounding communities it serves. The Community Cares about Suicide prevention community Coalition merged with WCDHU PFS grant to align alcohol, drug, mental health education and awareness in our county. St. Aloisius is a member of the Community Cares group. This group meets regularly and support the teen center Penny House activities. Annual Walk out of Darkness 5K event has been completed 3 times now and TEXT TIPLINE magnets have been distributed throughout the communities. Weekly KHND radio slots, St Aloisius talks providing health education of current and relevant heath issues.St. Aloisius Medical Center and WCDHU collaborated on a UND Community Health grant that specifically provided coffee talks and community event with discussion regarding Mental Health Stigma and awareness. Grief class was provided and materials purchased. St. Aloisius and Harvey Public School staff held a walking steps challenge where daily steps were tracked for four weeks and compared each week to challenge each other. St. Aloisius received the travelling trophy.St. Aloisius Medical Center has designated a staff person to work directly with the PFS (Partnership for success) federal grant for decreasing underage drinking. Beth Huseth worked 16 hours a week in time frame selected.Monthly "Did you know" ads in local paper provided by Community Cares funds with emphasis on Mental Health stigma. The Department of Health provided information on Dram laws and included Harvey Police Dept. and WC sheriff's office. Splash Dash 5K walk/run was held in July 2018. $1,500 was raised for the Community Cares Coalition.The Community Cares Coalition will begin meeting with the Partnership for Success (PFS) grant students in January 2019 at the HHS on Wednesday mornings.The PFS continues to work with students in decreasing underage drinking by launching several initiatives in the community. PFS Grant has added ten teens to the grant program who are actively working in the community regarding e-cigarettes, JULS, underage drinking and community health. They have met with ND State Representative Jon Nelson and will testify at the legislature in 2019.Grief support classes were held in fall of 2018 with Wells County Health and First Lutheran Church pastor.II. Collaboration with local EMS and the school system St. Aloisius Medical Center began working very closely with the local EMS in Early April of 2016. The relationship between the EMS and hospital had been positive but communication needed work. Both entities worked closely to educate the public on the need for a mill levy to support EMS operations. In addition, the hospital assisted the EMS in the development of their first budget. Since the approval of the mill levy, the hospital's Director of Nursing has been appointed as a member of the EMS board.OBJECTIVE: Improve collaboration with local EMS and the school systemResults 2017-2018:Routinely meet with the Ambulance Director to continue to improve communication, teamwork and discuss innovative ways of partnering.The Hospital participated in the CO-OP program with Harvey High School employing students a couple of hours per week. |
| St. Aloisius Hospital | Part V, Section B, Line 16j: A note is printed on monthly statements providing information regarding financial assistance. The financial assistance policy is provided to self-pay patients upon registration at the Hospital. It is not provided to all patients. The Uncompensated Care & Service Application and information regarding the financial assistance policy is available on our website and available upon request. |
| Part V, Section B, Line 7a, CHNA website: | www.staloisius.com/resources-policies.html |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - St Aloisius Long Term Care | ||||
| 325 Brewster Street East | Harvey | ND | 58341 | Skilled nursing facility |
| 2 - St Aloisius Senior Housing | ||||
| 325 Brewster Street East | Harvey | ND | 58341 | Senior housing units |
| 3 - St Aloisius Medical Center Clinic | ||||
| 317 Brewster Street East | Harvey | ND | 58341 | Clinic |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 6a: | The Organization's community benefit report can be found on its website at www.staloisius.com. |
| Part I, Line 7: | Charity care expense was converted to cost on an overall cost-to-charge ratio addressing all patient segments. Inpatient and outpatient Hospital services provided to Medicaid program beneficiaries are primarily paid on a cost-related basis, therefore there is no community benefit related to Medicaid on line 7b. Community health improvement services and cash and in-kind contributions are reported based on actual expenses recorded in the Organization's general ledger. The cost for subsidized health services reported on line 7g was determined using the Medicare cost report. |
| Part I, Ln 7 Col(f): | The amount of bad debt expense removed from total expenses to determine the percentage was $320,684. |
| Part II, Community Building Activities: | Our staff participated in community civic groups, boards and committees such as Kiwanis, Knights of Columbus, school board, Harvey Community Library Board, Relay for Life and Community Cares. |
| Part III, Line 2: | Before an account is written off to bad debt all discounts and payments are applied, including contractual allowances and discounts. Payments on accounts that were written off as bad debt reduces bad debt expense. Bad debt expense on line 2 is reported at charges as presented on the financial statements. |
| Part III, Line 3: | The estimated amount of the Organization's bad debt expense attributable to patients eligible under the organization's charity care policy is based on 5.7% of individuals living below the federal poverty level. The amount on line 3 is an estimate amount that could reasonably be attributable to patients who likely would have qualified for financial assistance under the charity care program if sufficient information had been obtained to make a determination of their eligibility. |
| Part III, Line 4: | The footnote to the Organization's financial statements can be found on page 7 and 8 of the attached audited financial statements. |
| Part III, Line 8: | St. Aloisius Hospital provides services to patients under the Medicare program knowing they will not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, the Medicare shortfall is considered a community benefit.Total revenue received from Medicare is the gross reimbursement plus settlement. Both total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. |
| Part III, Line 9b: | Patients that are in the process of applying for charity care or have been approved for charity care will not have collection procedures brought on them. If a patient does not complete the Caring Program application within 120 days the account will follow the same collection procedure as other accounts. Accounts turned over to collections may be eligible for the Caring Program if the patient completes an application and is approved within an additonal 120 days. After a determination of charity care, any personal portion due would follow the same collection procedures as other patients. Persons that have been granted bankruptcy by the courts are transferred to the Caring Program and written off as charity care. No collection procedures are pursued. |
| Part VI, Line 2: | To help inform future decisions and strategic planning, St. Aloisius Medical Center in Harvey, North Dakota conducted a community health needs assessment. Through a joint effort, St. Aloisius and Wells County District Health Unit analyzed community health-related data and solicited input from the community as a whole. Data for this community health needs assessment was collected in a variety of ways: (1) a broadly distributed survey solicited feedback from area residents; (2) another version of the survey gathered input from health care professionals; (3) community leaders representing the broad interests of the community took part in one-on-one key informant interviews; and (4) a wide range of secondary sources of data was examined, providing information on a multitude of measures including demographics; health conditions, indicators, and outcomes; rates of preventive measures; rates of disease; and at-risk activities. The assessment was conducted in three phases.During the Research Phase, community health, youth risk, community crime, American Hospital Association, and Centers for Disease Control summary data were analyzed. This analysis improved our understanding of our community and informed the study design. The second CHNA was completed and posted to the website by 9/30/2016.St. Aloisius addresses needs throughout the community in addition to completing the CHNA. The Hospital employs a marketing/public relations individual that is active with the local schools and provides feedback on needs in the community. A community care program was formed to address and help with suicide prevention. The Hospital has other activities to assist families in need throughout the community. |
| Part VI, Line 3: | St. Aloisius has a Revenue Cycle Manager, RCM, who works in conjunction with the business office staff on reviewing patient accounts both with insurance and those who are self-pay. Our monthly billing statements include information regarding financial assistance. The financial assistance policy is provided to self-pay patients upon registration at the Hospital. It is not provided to all patients. The application for Uncompensated Care and Services and information regarding the financial assistance policy is available on our website and available upon request.The hospital nurses ask the patient if they have any financial concerns about their hospital stay and if they do, the nurse calls the RCM or CFO to notify them that the patient has financial questions. The RCM or CFO will then follow up with the patient about their concerns. |
| Part VI, Line 4: | St. Aloisius Medical Center is a non-profit Critical Access Hospital located in central North Dakota. We serve more than 15 rural communities including Harvey where we are located. Our area of service is approximately 90 miles in diameter. Local doctors have clinics in Harvey, Fessenden (17 miles away) and Drake (23 miles away). In 2017, 33.2% of the residents in North Dakota are considered obese versus 39.6% nationally. In Wells County, 50% of households have one or more seniors (60 and older). Unemployment in North Dakota in 2018 was 2.6%. The estimated median household income was $61,843. Also, 11.5% of residents had income below the poverty level.Services offered include acute care, swing bed, surgery, senior housing and long-term care services. Our average acute/swing bed daily census is 5.3 patients. St. Aloisius Medical Center has provided services in Harvey since 1938 with the Sisters of Mary of the Presentation Health System. With a special mission to serve the poor, the Sisters' have offered healing hospitality to all who come to us for care.The closest critical access hospitals are Heart of America Medical Center located in Rugby, ND approximately 42 miles away and Carrington Health Center located in Carrington, ND approximately 54 miles away. |
| Part VI, Line 5: | The Organization's governing body is composed of representatives from Harvey and surrounding local communities in addition to representatives from the Sisters of Mary of the Presentation. The group is diverse, as it includes lay people, religious representatives and business men and women. This diversity represents the rural population we serve. Five Board Members are from the city of Harvey and the other two Board Members reside outside of Harvey.This facility extends medical staff privileges to those qualified practitioners based on an established credentialing process. We are not a research facility. Any excess funds are reinvested into funded depreciation for future capital projects for the facility. As a critical access facility, there have not been many years with excess funds, but when there is, the facility has made improvements in building infrastructure to increase quality and efficiency for our patients and residents we serve.The facility has a 24/7 emergency room available to patients regardless of ability to pay.Examples of services St. Aloisius has provided to the community at large:1. Sponsored weekly radio spots where health issues were addressed.2. Provided 24/7 pastoral care services.3. Provided exercise/fitness area for the community in our cardiac rehab center. This year there were 284 people who used the wellness center visits for 681 encounters.4. Provided lab services to 977 patients during our spring and fall Wellness Days.5. Provided Natural Family Planning services to the community with seven couples participating.6. Our newly hired Diabetic Educator started DEEP classes on diabetic education with 33 participants as well as counseled 31 acute and swing bed patients7. With our new Cardiac Ready Community Project, we conducted blood pressure screenings for 781 patients, where 27 were referred to their providers for further follow up. We also trained 438 community members on hands only CPR8. We provided sports physicals to 90 area athletes and their payments for the physicals was donated to Wells County Booster club9. Provided Suicide prevention education to the schools in the county and worked with the Community Cares on suicide prevention events10. Provided donations to local school projects and other community groups, memorial services, child protection referrals11. Presented bi-weekly "Did You Know" health information in the local newspaper 12. Provided office space (in kind) for Public Health, WIC (Women Infant's & Children program) where they saw 1,200 clients13. Provided office space (in kind) for Hearing Aid Services and Rural Mental Health consortium staff/clients in our outpatient services building. There were 156 people served with 515 encounters by the Rural Mental Health staff.14. Provided cable television, internet and phone to our patients and residents which is non- reimbursable on our cost report15. Provided use of the Presentation Center for meetings/celebrations.16. Sent outdated supplies to local missionaries for distribution in the Philippines. |
| Part VI, Line 6: | We are an affiliate of the Sisters of Mary of the Presentation Health Corporation. St. Aloisius Medical Center operates in accordance with the mission, vision, and values of the Sisters of Mary of the Presentation Health Corporation. Our annual budgeting process includes an assessment of how our budget demonstrates a commitment to the values of the system and the system works to ensure we are always mindful of our duty to care for the poor and those in need. St. Aloisius Medical Center has a Strategic Plan developed from themes set forth by the health system for all affiliates. The strategic plan is an active document which St. Aloisius Medical Center works on continuously and reports back to the health system on our progress toward established goals which again, align with the mission, vision, and values of the organization. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Michael Zwicker | ||||||||||||||
| President/CEO | $0 | $194,000 | $0 | $0 | $0 | $6,000 | $0 | $0 | $0 | $25,472 | $0 | $225,472 | $0 | $0 |
| Sandra Teubner | ||||||||||||||
| CFO | $0 | $130,600 | $0 | $8,963 | $0 | $3,063 | $0 | $6,837 | $0 | $27,619 | $0 | $177,082 | $0 | $0 |
| Kimberly Thorson | ||||||||||||||
| Nurse Practitioner | $175,865 | $0 | $0 | $0 | $0 | $0 | $5,276 | $0 | $0 | $0 | $181,141 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule J, Part I, Question 3: | FormAndLineReferenceDesc |
| Explanation | St. Aloisius Medical Center does not pay compensation to the CEO. This individual is compensated by Sisters of Mary of the Presentation Health System, a related organization, for services at the Hospital. Sisters of Mary of the Presentation Health System uses one or more of the methods on Part I, question 3 to determine compensation. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, line 2 | Diabetic education services for inpatients and outpatients which began in 2018. Opened an outpatient clinic August 6, 2018. |
| Form 990, Part III, line 3 | New Graston Technique offered in physical therapy department. |
| Form 990, Part VI, Section A, line 2 | Mark Zwicker and Sandra Teubner have a business relationship. |
| Form 990, Part VI, Section A, line 6 | The sole member of the Organization is the Sisters of Mary of the Presentation Health System. |
| Form 990, Part VI, Section A, line 7a | The member is entitled to vote in the election of Directors and to cast one vote for each Director to be elected. The member is also entitled to one vote on every other matter to be voted on by the member. Votes cast on behalf of the member are cast by the Chief Executive Officer of Sisters of Mary of the Presentation Health System. |
| Form 990, Part VI, Section A, line 7b | The authority to act on the following matters are exclusively vested in the member of the organization: 1. any change in the philosophy, objectives and purposes of the organization; 2. amendment of the articles of incorporation and bylaws; 3. the election or removal of the Directors; 4. merger or consolidation with any other organization; 5. dissolution of the organization or the sale, lease or exchange of all or substantially all of its property or assets; 6. the sale, lease, transfer or encumbrance of any land, buildings or other assets owned by the organization or in which the organization has or will have equitable or legal title; 7. approval of the annual operating and capital budgets; 8. appointment of the Chief Executive Officer. |
| Form 990, Part VI, Section A, line 8b | The Organization does not have committees with authority to act on behalf of the governing body. |
| Form 990, Part VI, Section B, line 11b | The Form 990 is provided to the governing Board before it is filed. The Organization's CEO and CFO review the 990. |
| Form 990, Part VI, Section B, line 12c | Each Director must submit in writing to the Chairperson of the Board and the Chief Executive Officer a list of all business or other organizations of which the individual is an officer, director, trustee, member, owner (either as a sole proprietor or partner), shareholder with a 5% or greater interest in all outstanding voting shares, employee or agent, with which the organization has, or might reasonably in the future enter into, a relationship or a transaction in which the Director would have conflicting interests. Each written statement is resubmitted with any necessary changes each year. The Chairperson of the Board reviews the statements of the Directors and the Vice Chairperson of the Board reviews the statement filed by the Chairperson. When a conflict arises the affected Director makes known the potential conflict, whether disclosed by written statement or not, and after answering any questions, will withdraw from the meeting for as long as the matter continues under discussion. Should the matter be brought to a vote, the affected Director will not vote on it. In the event the Director does not withdraw voluntarily, the Chairperson of the Board has authority to require the Director to remove himself from the room during both the discussion and vote on the matter. In the event the conflict of interest affects the Chairperson, the Vice Chairperson has authority to require the Chairperson remove himself in the same matter. If the matter is the item of business for which a special meeting of the Board was called, the affected Director will not be counted to establish a quorum, and he will not participate in the deliberations or vote on it. |
| Form 990, Part VI, Section B, line 15 | The Organization's CEO and CFO are both compensated by Sisters of Mary of the Presentation Health System, a related organization. The compensation process is determined by the related organization. The Sisters of Mary of the Presentation Health System Board of Trustees directly engages a nationally recognized independent compensation consulting firm to review the total compensation arrangements of the officers and key employees. The Sisters of Mary of the Presentation Health System Board of Trustees approves all compensation based on comparable data and documents their decision in the meeting minutes. |
| Form 990, Part VI, Section C, line 19 | The Organization's governing documents, conflict of interest policy, and financial statements are not available to the public. Financial information is available through the public disclosure copy of the 990. |
| Form 990, Part IX, line 11g | Purchased services: Program service expenses 760,043. Management and general expenses 31,195. Fundraising expenses 0. Total expenses 791,238. Professional fees: Program service expenses 529,501. Management and general expenses 760,673. Fundraising expenses 0. Total expenses 1,290,174. |
| Form 990, Part XI, line 9: | Equity transfer to related party -9,804. |
| Form 990, Part XII, Line 2C: | The governing Board of Sisters of Mary of the Presentation Health System assumes responsibility for oversight of the audit for St. Aloisius Hospital. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Sisters of Mary of the Presentation Health System | ||||||||||
| 1202 Page Drive SW | Fargo | ND | 58103 | 450359620 | Facilitates management and operations of ten related facilities | ND | 501(c)(3) | Line 12b, II | SMP Health Ministry | 0 |
| Presentation Medical Center | ||||||||||
| 213 2nd Avenue NE | Rolla | ND | 583670759 | 450227391 | Provision of health care services | ND | 501(c)(3) | Line 3 | SMP Health System | 0 |
| St Margaret's Hospital | ||||||||||
| 600 East First Street | Spring Valley | IL | 61362 | 362167884 | Provision of health care services | IL | 501(c)(3) | Line 3 | SMP Health System | 0 |
| St Andrew's Hospital | ||||||||||
| 316 Ohmer Street | Bottineau | ND | 58318 | 450226426 | Provision of health care services | ND | 501(c)(3) | Line 3 | SMP Health System | 0 |
| Sisters of Mary of the Presentation Long Term Care | ||||||||||
| 1202 Page Drive SW | Fargo | ND | 581060007 | 752999939 | Provide extended care and medically related services | ND | 501(c)(3) | Line 11 | SMP Health System | 0 |
| St Andrew's Hospital Foundation | ||||||||||
| 316 Ohmer Street | Bottineau | ND | 58318 | 450413201 | Assist St. Andrew's Hospital in fund raising and fund management | ND | 501(c)(3) | Line 12b, II | SMP Health System | 0 |
| Prairieland Home Care | ||||||||||
| 1102 Page Drive SW | Fargo | ND | 581060007 | 450391192 | Home health and supportive services | ND | 501(c)(3) | Line 11 | SMP Health System | 0 |
| St Margaret's Hospital Foundation | ||||||||||
| 600 East First Street | Spring Valley | IL | 61362 | 364042262 | Provide support to St. Margaret's Hospital | IL | 501(c)(3) | Line 12b, II | SMP Health System | 0 |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| St Andrew's Bottineau Clinic LLC | |||||||
| 316 Ohmer Street | Bottineau | ND | 58318 | 450451306 | Provision of health care services | ND | N/A |
| Valley Regional Health Services L3C | |||||||
| 4391 Venture Drive | Peru | IL | 613541014 | 273891281 | Outpatient oncology services | IL | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| SMP Enterprises | |||||||||
| PO Box 10007 | Fargo | ND | 581060007 | 363486506 | Collection Agency | ND | N/A | C | 0 |
| SMP Enterprises - IL | |||||||||
| 600 East 1st Street | Spring Valley | IL | 61362 | 363456566 | Healthcare Management | IL | N/A | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |